The Past, Present, and Future of Unilateral Biportal Endoscopy with a Technical Note on Novel Endoscopic Visualization Pedicle Screw Insertion Technique and UBE-transforaminal Lumbar Interbody Fusion Technique with Literature Review.

Introduction: Over the past two decades, unilateral biportal endoscopy (UBE) has brought a new paradigm shift in the surgical treatment of spinal disorders with its innovative technique. This study aims to review the development of the UBE technique with a technical note on the novel endoscopic visualization pedicle screw (EVPS) insertion technique and UBE-transforaminal lumbar interbody fusion technique (UBE-TLIF). Case Report: A 66-year-old female presented with severe back pain (Visual Analog Scale [VAS] 8/10) and radicular pain in both legs (left > right) (left VAS 7/10 and right VAS 7/10) for one year with an Oswestry disability index (ODI) score of 70%. Her pain aggravated when bending forward and performing daily routine activities. She also complained of severe intermittent neurological claudication at a distance of <50 m. On physical examination, power in the lower limbs was 5/5 as per the Medical Research Council grading, and deep tendon reflexes were normal. She had a known case of diabetes mellitus and hypertension and was on treatment with oral medications. Pre-operative X-ray and magnetic resonance imaging showed dynamic instability with spondylolisthesis at L4-5. We performed UBE-TLIF with the EVPS insertion technique to resolve her symptoms. The operative time was 122 min; blood loss was 40 mL. After surgery, the patient was followed up at one week, six weeks, three months, six months, 12 months, and two years. The pain and tingling sensation in the legs improved at the 1-week follow-up, with a VAS score of 0/10 and an ODI score of 10% at the 2-year follow-up. Patient satisfaction was surveyed using Macnab's criteria at the final follow-up visit of 2 years and was found to be excellent. Post-operative imaging showed a good reduction and canal decompression at L4-5. Conclusion: The novel EVPS insertion technique and UBE-TLIF have the advantages of minimally invasive spine surgery; they are a safe and effective treatment option for treating lumbar spine pathologies.